Provider Demographics
NPI:1992115075
Name:PREMIER CARE MEDICAL TRANSPORT LLC
Entity type:Organization
Organization Name:PREMIER CARE MEDICAL TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DELVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHARLESTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-949-1082
Mailing Address - Street 1:17 MADISON LN
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-4410
Mailing Address - Country:US
Mailing Address - Phone:609-949-1082
Mailing Address - Fax:856-875-2275
Practice Address - Street 1:17 MADISON LN
Practice Address - Street 2:
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-4410
Practice Address - Country:US
Practice Address - Phone:609-949-1082
Practice Address - Fax:856-875-2275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-29
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1006943416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport